Biomedical subjects

Y Kakeji

Publications and source records attributed to Y Kakeji.

At least 73 records · Page 4Linked to original sources

PubMed1993

Prognostic significance of flow cytometric analysis of DNA content in colorectal cancer: a prospective study.

We prospectively analyzed the tumor DNA content by flow cytometry in 100 patients who underwent a curative resection for colorectal cancer between August 1989 and May 1992 in order to evaluate the prognostic significance of DNA ploidy and the DNA index (DI). Patients with aneuploid tumors were found to have a significantly shorter disease-free survival than those with diploid tumors (P = 0.014). In addition, patients who had tumors with a DI greater than 1.6 had a significantly shorter disease-free survival than those who had tumors with a DI of less than 1.6 (P = 0.0001). After stratification by stage, this association was only seen in Dukes' stage C disease (P = 0.0065). Cox's regression analysis demonstrated that the DI (below or above 1.6) rather than DNA ploidy was an important independent predictor of disease-free survival. These results suggest that the DI rather than DNA ploidy provides us with important prognostic information in patients undergoing curative surgery for colorectal cancer.

Adenocarcinoma↗

PubMed1993

Gastric cancer with p53 overexpression has high potential for metastasising to lymph nodes.

Overexpression of the tumour suppressor gene p53 was investigated immunohistochemically in 96 primary gastric carcinomas and 26 corresponding metastatic perigastric lymph nodes. Abnormalities in p53 expression were found in 52 (54%) of the 96 primary carcinomas. Tumours stained positively for p53 frequently metastasised to lymph nodes (the metastatic rate: 85%) compared to findings in those with negative p53 staining (64%, P < 0.05). Ninety-two percent (24/26) of the malignant cells in the lymph nodes stained positively for p53. When the DNA ploidy pattern of the tumour was determined by flow cytometry, the aneuploid tumours in p53 positive and negative groups accounted for 69% and 45%, respectively (P < 0.05). Proliferative activity of the tumour, as measured by Ki-67 labelling, was significantly higher (30.6 +/- 12.0%) in the p53 positive group than that (25.1 +/- 10.7%) in the p53 negative group (P < 0.05). Thus, gastric cancer with a mutant p53 has high proliferative activity and metastasis to lymph nodes will probably occur.

DNA, Neoplasm↗

PubMed1993

The prognostic significance of proliferating cell nuclear antigen in clinical gastric cancer.

BACKGROUND: Proliferating cell nuclear antigen (PCNA) is an intranuclear protein that is closely linked to the cell cycle. This antigen can be detected in formalin-fixed specimens. We studied the expression of PCNA in primary gastric cancer to identify its significance as a prognostic factor. METHODS: The avidin-biotin-peroxidase complex method was used for PCNA staining in sections from 138 patients with primary gastric cancer. All sections were formalin fixed and paraffin embedded. Two different sections were examined in each case. RESULTS: The PCNA labeling index (PCNA-positive cells/1000 cells x 100) varied from 7.0% to 59.7%. There were significant differences in tumor size, morphologic type, depth of tumor invasion, lymphatic permeation, vascular permeation, and lymph node metastasis between the high (> or = 33.4) and low (< 33.4) PCNA labeling index groups. The 5-year survival rates of the high and low PCNA labeling index groups were 5.8% and 66.2%, respectively, a significant difference (p < 0.001). Multivariate analysis showed that the PCNA labeling index was an independent prognostic factor for gastric cancer. CONCLUSIONS: Because PCNA immunostaining can be done in routine formalin-fixed paraffin-embedded sections, this could be a powerful tool for providing information about the prognosis of patients with gastric cancer.

Antigens, Neoplasm↗

PubMed1993

[Pharmacodynamic study on the effectiveness of UFT against cancer of gastro-intestinal (GI) tract].

Preoperative oral administration of either 5-FU 200 mg/day (15 patients) or UFT (tegafur plus uracil at a 1:4 molar ratio) 400 mg/day (22 patients) were carried out was carried out against the patients cancer of GI-tract 3 consecutive days till the morning of the operation. Serial blood samples of peripheral and portal veins were obtained for the measurement of concentration of 5-FU. The Concentration of 5-FU in normal and tumor tissues was measured in 13 patients given UFT pre-operatively. Thymidylate synthase inhibition rate were also measured in 5 of them. Furthermore, AgNOR count of tumor tissue before and after administration of UFT were examined in 11 patients. Following conclusions were obtained. (1) The Concentration of 5-FU in peripheral venous blood of UFT group was significantly higher than that of 5-FU group during 1-5 hrs after the last dose (p < 0.05). (2) The concentration of 5-FU in portal venous blood of 5-FU group was higher than that of UFT group during initial 2 hrs after the last dose. However, during 3 to 7 hrs after the last dose, UFT group showed a higher concentration. (3) In UFT group, the concentration of 5-FU in tumor tissue was significantly higher than that in normal tissue (p < 0.01). Consequently, preoperative administration of UFT can be effective for prevention of intraoperative prevention of hematogenous metastasis via portal system in cancer of gastrointestinal tract.

Administration, Oral↗

PubMed1992

Superficial flat-type early carcinoma of the stomach.

A clinicopathologic study was done on 21 cases of superficial flat-type early gastric carcinoma (IIb type EGC). In one case there was the two IIb type EGC. Nine patients had no symptoms, whereas the other 12 had either epigastralgia, hematemesis, or anorexia. The preoperative diagnosis was accurate in 15 patients; eight were demonstrated by barium study, and 13 by endoscopy. The suspicious finding of IIb type EGC was either the disappearance or irregularity of the areae gastricae by barium study and a mucosal color change by endoscopy. Well-differentiated or moderately differentiated adenocarcinomas showed a slight redness of the affected mucosa whereas the poorly differentiated adenocarcinomas were pale in color. Histologically, many well-differentiated or moderately differentiated adenocarcinomas occupied the entire thickness of the mucosal layer whereas most of the poorly differentiated adenocarcinomas spread horizontally with preservation of non-cancerous glands and foveolae. The growth pattern was super type in ten lesions and small mucosal type in 12 and no pen-type growth was seen. Concerning the cell nuclear DNA ploidy pattern, 21 showed a low ploidy pattern and only one had a high ploidy pattern. The IIb type EGC seemed to have a less malignant potential from the viewpoint of growth pattern and DNA ploidy pattern. Care must be taken at the proximal line of excision of the tumor so as not to leave behind residual carcinoma cells.

Adenocarcinoma↗

PubMed1992

Noncurative resection for advanced gastric cancer.

Between 1965 and 1985, 489 patients with advanced gastric cancer who were treated with gastric resection and in whom tumor cells remained after the operation were defined as cases of a "noncurative resection." The clinicopathological features and prognosis of these patients were examined and two groups were prepared: locally advanced cancer and cancer with a distant metastasis. In locally advanced cancer cases, tumor cells remained in the neighboring organs, lymph nodes, and/or resected margins; in those with distant metastasis, peritoneal dissemination and/or liver metastasis were present regardless of whether or not the metastasis was removed, with or without locally noncurative factors. Serosal invasion was prominent and high rates of lymph node metastasis and lymphatic involvement were evident in both groups. The survival rate for patients with locally advanced gastric cancer was better than that of patients with distant metastasis (P < 0.01). Survival time in patients with locally advanced cancer can be lengthened by resecting all of the primary tumor and as much of the metastatic lesions as possible, even if the surgical management is "noncurative." Aggressive postoperative chemotherapy for patients with distant metastasis from a gastric cancer is to be recommended.

Aged↗

PubMed1992

Prognosis for surgically treated gastric cancer patients is poorer for women than men in all patients under age 50.

From 1965 to 1983, 1031 patients (689 men and 342 women) with advanced gastric cancer underwent gastric resection in our department. A retrospective study was done with special reference to the sex of the patients. The age, tumour size and location, Borrmann type, and histology were considered as the sex-related associations. The survival rate of women under age 50 years was lower than that of men, with a significant difference (P less than 0.01), and the 10-year survival rate was 39.2% for the men and 29.3% for the women. A multivariate analysis showed that the operative curability (relative risk: 2.11), lymph node metastasis (relative risk: 1.37), depth of invasion (relative risk: 1.30) and tumour size (relative risk: 1.05), all significant prognostic factors, differed between the men and women under age 50 years, and the survival rate for women was lower. Thus, early detection of gastric cancer is crucial to improve the survival of women under age 50 years. Postoperative chemotherapy may be considered for those with an advanced gastric cancer.

Adult↗

PubMed1992

Non-polypoid inflammatory fibroid polyps concomitant with early carcinoma in the stomach.

A 69-year-old Japanese woman with early carcinoma of the stomach was treated. Postoperative pathological examination of the resected stomach disclosed a widely spreading early carcinoma and two concomitant submucosal lesions which were histologically compatible with inflammatory fibroid polyp (IFP). Neither IFP showed a polypoid appearance: instead they had a down-growth pattern. The covering mucosa was replaced by gastric carcinoma cells. The IFPs were located mainly in the submucosa, but reached invasively to the subserosa through the proper muscular layer. The boundaries of the lesions were well demarcated in the submucosa but poorly demarcated in the subserosa. This case is very rare because the two IFPs showed a down-growth pattern and were concomitant with early gastric carcinoma.

Adenocarcinoma↗

PubMed1992

Trends in survival rates in Japanese patients with advanced carcinoma of the stomach.

From 1965 to 1985, 1,150 patients underwent gastrectomy for carcinoma of the stomach invading beyond the submucosa. One thousand, one hundred and forty-one patients were studied for five years or longer. The patients were classified into two groups--those treated from 1965 to 1974 (n = 622) and those treated from 1975 to 1985 (n = 519). In the more recent group, there was a significant increase in the number of patients more than 70 years of age, in the number of female patients, of carcinomas present in the upper two-thirds of the stomach, in tumors exceeding 10 centimeters and diffusely infiltrative type and in early cancer-simulating type of advanced carcinoma in gross appearance and in undifferentiated type adenocarcinomas in histology. Although differences in the incidence of patients treated by radical procedures, such as extensive lymph node dissection and combined resection of adjacent organs, were not statistically significant, the incidence for those who underwent total gastrectomy was significantly increased. The over-all long term survival rate remained unchanged during 1965 to 1985 (five year survival rate of 31.3 versus 32.8 per cent). However, there was a significantly longer survival period for patients who underwent total gastrectomy (five year survival rate of 22.9 versus 28.3 per cent) (p less than 0.05). Much of the improvement can be attributed to an increase in the detection of relatively small advanced carcinomas and of advanced carcinomas of the stomach simulating early carcinoma in the upper one-third of the stomach. Therefore, we emphasize the need to diagnose advanced carcinoma of the stomach when the lesion is in an earlier stage of disease.

Adenocarcinoma↗

PubMed1992

Lower survival rate for patients with carcinoma of the stomach of Borrmann type IV after gastric resection.

Between 1965 and 1985, 194 of 1,113 patients (17.4 percent) with advanced carcinoma of the stomach who underwent gastric resection had Borrmann type IV carcinoma of the stomach, a macroscopically evident and diffusely spreading tumor. These patients tended to be younger and female and to have larger tumors that involved the entire stomach, as compared with patients with other types of carcinomas. Tissues were commonly undifferentiated, serosal invasion was prominent with infiltrative growth and high rates of metastasis to the lymph nodes and peritoneal dissemination were evident. In most instances, the disease was advanced; therefore, total gastrectomy was performed upon 82.0 percent of the patients and a palliative resection was done in 64.4 percent. The survival rate was lower than for patients with carcinoma of the stomach of other types (p less than 0.01). A multivariate analysis indicated that curative resection is an independent favorable prognostic event, while other factors are dependent covariates. Early detection of this carcinoma is crucial to extend survival time of patients with Borrmann type IV carcinoma of the stomach. Aggressive postoperative chemotherapy should be considered when a noncurative resection is done.

Female↗

PubMed1991

DNA ploidy is associated with growth potential in gastric carcinoma.

To correlate growth potential with DNA ploidy 109 patients with early gastric carcinoma and 132 patients with advanced gastric carcinoma were studied. Early gastric carcinomas were classified by growth potential into the small mucosal type, the superficially spreading (super) type, or the expansively penetrating (Pen A)/infiltratively penetrating (Pen B) types. Advanced gastric carcinomas were classified into funnel, column, or mountain types, each of which was divided further into expanding and infiltrative types. Cell nuclear DNA content was measured by microspectrophotometric study and classified as either low or high ploidy according to the degree of dispersion on the DNA histogram. Super type early and funnel type advanced carcinomas, characterized by superficially spreading growth, were more likely to have low DNA ploidy. In contrast, Pen A type early and column-expanding type advanced carcinomas, characterized by expansively penetrating growth, were more likely to have high DNA ploidy.

DNA, Neoplasm↗

PubMed1991

Helix pomatia agglutinin binding activity is a predictor of survival time for patients with gastric carcinoma.

The authors used helix pomatia agglutinin (HPA) staining to examine 163 primary gastric carcinoma isolates, using the avidin-biotin-peroxidase complex method. The positive HPA staining rate was 59% (96/163) for the primary tumors, and the positive staining correlated well (with statistical significance) with tumor enlargement, penetration, lymphatic invasion, and metastasis (P less than 0.01), and with infiltrative spread (P less than 0.05). Patients with gastric cancer showing positive HPA staining had a lower survival rate (P less than 0.001), particularly when the cancer cells were present on the serosal surface. Careful follow-up and intensive postoperative therapy are required for patients with an HPA-positive advanced gastric carcinoma.

Acetylgalactosamine↗

PubMed1991

Clinicopathologic features and prognostic significance of duodenal invasion in patients with distal gastric carcinoma.

Clinicopathologic features and prognostic significance of duodenal invasion were studied in a retrospective study on 593 patients who underwent gastrectomy for adenocarcinoma in the antrum. The patients were grouped into three, according to the histologic extent of duodenal invasion: Group A (80 patients), obvious invasion beyond the pyloric ring; Group B (61 patients), invasion up to the pyloric ring; and Group C (452 patients), no evidence of duodenal invasion. Five-year survival rates in Groups A, B, and C were 7.9%, 31.6%, and 57.6%, respectively (P less than 0.001). Cox's regression analysis showed that duodenal invasion is an independent prognostic factor in cases of a gastric antrum carcinoma. Gastric cancer with duodenal invasion (Groups A and B) most often was infiltrative and the incidence of serosal invasion, lymphatic and vascular invasion, and lymph node metastasis was high. Duodenal invasion was direct through submucosal or subserosal layers or through submucosal lymphatics.

Adenocarcinoma↗

PubMed1991

Predictive value of Ki-67 and argyrophilic nucleolar organizer region staining for lymph node metastasis in gastric cancer.

Proliferative activities in 91 primary gastric carcinomas and 36 corresponding metastatic perigastric lymph nodes were investigated using Ki-67 labeling percentage and an argyrophilic nucleolar organizer region (AgNOR) count. Tumors with a high proliferative activity often metastasized to lymph nodes, and the proliferative activities of the primary lesion and the perigastric lymph node metastases were similar. A significant correlation was recognized between the Ki-67 labeling percentage and the AgNOR count (r = 0.744; P less than 0.001). The Ki-67 labeling percentage and AgNOR count proved to be useful predictors of nodal metastasis regardless of tumor size, depth of invasion, and histological type. Even when tumors are smaller (less than 7 cm) or the stage of the disease is early (pT1, 2), the formation of metastasis increased with an increased Ki-67 labeling percentage or AgNOR count. The combination analysis of depth of invasion with Ki-67 labeling percentage or AgNOR count gives a more precise prediction of nodal metastasis, compared with histological analysis alone.

Antibodies, Monoclonal↗

PubMed1991

Comparison of R1 and R2 gastrectomy for gastric cancer in patients over 80 years of age.

To evaluate the benefit of R2 gastrectomy for gastric cancer in Japanese patients over 80 years of age, data on 93 patients who underwent gastrectomy between 1967 and 1989 were collected retrospectively from charts filed in the Kyushu University Hospital and two affiliated national hospitals. Of 93 patients, 62 had a localized tumor without evidence of metastatic spread. These 62 patients were classified into two groups according to the procedures performed: 35 underwent R1 gastrectomy and 27, R2 gastrectomy. The clinical and pathological characteristics of the patients in the two groups were comparable at the time of surgery, except that the group who underwent R1 gastrectomy was older. R2 gastrectomy involved a significantly longer operation time (P less than 0.01) and greater intraoperative blood loss (P less than 0.05) when compared to R1 gastrectomy, but no patient undergoing this extensive surgery died. The difference in the morbidity rate between the two groups was not statistically significant. The 5-year survival rate was 55.8% in the R1 group and 65.4% in the R2 group. When gastric cancer invaded the serosa and/or secondary nodes, a substantial increase in survival time was gained with R2 gastrectomy when compared to an R1 operation. These findings suggest that an R2 gastrectomy is feasible, even for patients over 80 years, but is indicated mainly when the carcinoma had invaded the serosa and/or secondary nodes and the patients are at good risk for major surgery.

Aged↗

PubMed1991

Prophylactic administration of urinary trypsin inhibitor prevents postoperative hyperamylasemia after R2 gastrectomy in patients with gastric cancer. A prospective randomized trial.

The purpose of this prospective randomized study was to determine whether prophylactic administration of urinary trypsin inhibitor prevents postoperative damage to the pancreas caused by R2 gastrectomy in patients with gastric cancer, by analyzing related enzyme activities. Among the 22 patients who underwent distal partial gastrectomy together with R2 lymphadenectomy, 12 were given the drug for 3 days postoperatively, and 10 no therapeutic agent. These groups were otherwise comparable. Postoperatively, the control patients had significantly higher levels of total amylase activity in the serum and P-type amylase when compared to the preoperative data. These amylase activities almost remained at the preoperative level in those given the drug. When the ratio of increase in enzyme activities (postoperative value divided by preoperative value) were compared, on the 7th postoperative day, total amylase activity in the serum and P-type amylase were significantly different between the two groups (p less than 0.05). This difference was also evident when comparing total amylase activity in the urine (p less than 0.05). These findings indicate that prophylactic administration of urinary trypsin inhibitor would aid in preventing postoperative hyperamylasemia caused by R2 gastrectomy in patients with gastric cancer.

Adult↗

PubMed1991

Prognostic factors in adenocarcinoma in the upper one-third of the stomach.

From 1965 to 1985, 356 of 1,468 patients (24.3 per cent) with carcinoma of the stomach who underwent gastric resection had disease arising from the upper one-third of the stomach. Tumors in the upper one-third of the stomach were larger, and gross appearance of types 3 and 4 was frequent. Serosal invasion was prominent, and the rates of metastases of the lymph nodes and liver were higher in carcinoma in the upper one-third of the stomach compared with carcinoma in other regions of the stomach. Palliative resection was done for 43.8 per cent of the patients. Survival rate for patients with carcinoma in the upper one-third of the stomach was lower than for patients with lesions in other regions of the stomach (p less than 0.01). Multivariate analysis indicated that operative curability, hepatic metastasis, serosal invasion, lymph node metastasis, peritoneal dissemination and tumor size are significant prognostic factors for carcinoma in the upper one-third of the stomach. These events, except for peritoneal dissemination, differed between carcinoma in the upper one-third of the stomach and in other regions of the stomach, and the survival rate for patients with carcinoma of the upper one-third of the stomach was less favorable. Early detection is crucial for improving the survival time of patients with carcinoma in the upper one-third of the stomach. Aggressive postoperative chemotherapy should be considered when noncurative resection is done.

Adenocarcinoma↗

PubMed1991

Hepatic recurrence not prevented with low-dosage long-term intraportal 5-FU infusion after resection of colorectal liver metastasis.

Seventeen patients with colorectal cancer metastatic to the liver underwent hepatic resection. For five we prescribed adjuvant therapy which included intraportal mitomycin C (MMC) and 5-fluorouracil (5-FU) and consecutive oral administrations of tegafur (N1-(2'-tetrahydrofuryl)-5-fluorouracil), in an attempt to reduce recurrences in the liver. Intraportal chemotherapy consisted of low-dosage, long-term 5-FU infusion, 40 days at 250 mg/day, and a 10 mg bolus injection of MMC at the start and the end of continuous 5-FU infusion. With regard to postoperative events in patients given the infusion therapy, there was no hepatotoxicity or hematologic toxicity, no mechanical complications and no pain or vomiting. Two of five patients given infusion therapy and six of 12 not given the therapy died within 5 years after surgery. There was recurrence in the liver in two patients given infusion therapy and in four not given the therapy. Although low-dosage, long-term intraportal chemotherapy is a safe treatment given hopefully to prevent hepatic recurrence, we found no beneficial effect.

Adult↗